Management of sinogenic subdural empyema in a 9-year-old child via minimally invasive burr-hole evacuation: a case report

We present here a case of a 9-year-old boy who was admitted with a dramatic neurological decline caused by bilateral subdural empyema secondary to pansinusitis. His symptoms included right-sided hemiplegia, global aphasia, and altered consciousness. Although aggressive, the initial antibiotic therapy failed to halt his deterioration, and an emergency surgical intervention became necessary. The patient underwent minimally invasive evacuation via two neuronavigated burr-hole craniotomies, which successfully drained the purulent collections. Postoperatively, he was managed with a multimodal regimen including broad-spectrum intravenous antibiotics, antiepileptic drugs, and a tapering course of corticosteroids. While intraoperative pus cultures were sterile, Streptococcus anginosus was isolated by blood culture, guiding a targeted six-week course of vancomycin and levofloxacin. The patient experienced a rapid and complete neurological recovery, with follow-up imaging confirming resolution of the empyema. This case highlights the efficacy of combining minimally invasive surgery with aggressive, tailored medical management for treating severe pediatric SDE, leading to an excellent outcome.